Provider Demographics
NPI:1376956722
Name:WALTERS, ALEX ANN (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALEX
Middle Name:ANN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359
Mailing Address - Country:US
Mailing Address - Phone:910-827-5404
Mailing Address - Fax:910-827-8057
Practice Address - Street 1:580 FARRINGDOM STREET
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-272-9056
Practice Address - Fax:910-272-9057
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist